2015 U.S. Transgender Survey: Report on the Experiences of American Indian and Alaska Native Respondents

This report highlights the specific experiences of transgender American Indians and Alaska Natives in many areas of life. It builds upon NCTE's groundbreaking 2015 U.S. Transgender Survey—the largest ever survey of transgender people in the nation, with nearly 28,000 respondents.Findings from the full USTS report revealed the disturbing patterns of discrimination and mistreatment that transgender people in the survey faced. These experiences were amplified for transgender people of color, including transgender American Indians and Alaska Natives, who faced deeper and broader forms of mistreatment in many of the most basic elements of life

Initiatives to integrate primary and acute health care, including ambulatory care services

Most people, at some time in their lives, will require health care services from multiple health care providers, whether it is for short-term unexpected ill health, long-term chronic conditions or co-morbidities that cross disciplines (eg. substance-related conditions and mental health). Integration of health services is particularly important for patients with chronic and complex conditions as they must frequently negotiate a path through different health care sectors, including primary, acute and ambulatory care services, as well as the public and private health jurisdictions. Standardised pathways for the more common chronic conditions may be needed to enable seamless transitions and avoid negative outcomes that may result from delays, duplications and errors in a system that operates as multiple independent organisations

Suppression of Alternative Lipooligosaccharide Glycosyltransferase Activity by UDP-Galactose Epimerase Enhances Murine Lung Infection and Evasion of Serum IgM

In pathogens that produce lipooligosaccharide (LOS), sugar residues within the surface-exposed LOS outer core mediate interactions with components of the host immune system, promoting bacterial infection. Many LOS structures are controlled by phase variation mediated by random slipped-strand base mispairing, which can reversibly switch gene expression on or off. Phase variation diversifies the LOS, however its adaptive role is not well-understood. Nontypeable Haemophilus influenzae (NTHi) is an important pathogen that causes a range of illnesses in the upper and lower respiratory tract. In NTHi a phase variable galactosyltransferase encoded by lic2A initiates galactose chain extension of the LOS outer core. The donor substrate for Lic2A, UDP-galactose, is generated from UDP-glucose by UDP-galactose epimerase encoded by galE. Our previous fitness profiling of H. influenzae mutants in a murine lung model showed that the galE mutant had a severe survival defect, while the lic2A mutant's defect was modest, leading us to postulate that unidentified factors act as suppressors of potential defects in a lic2A mutant. Herein we conducted a genome-wide genetic interaction screen to identify genes epistatic on lic2A for survival in the murine lung. An unexpected finding was that galE mutants exhibited restored virulence properties in a lic2A mutant background. We identified an alternative antibody epitope generated by Lic2A in the galE mutant that increased sensitivity to classical complement mediated killing in human serum. Deletion of lic2A or restoration of UDP-galactose synthesis alleviated the galE mutant's virulence defects. These studies indicate that when deprived of its galactosyl substrate, Lic2A acquires an alternative activity leading to increased recognition of NTHi by IgM and decreased survival in the lung model. Biofilm formation was increased by deletion of galE and by increased availability of UDP-GlcNAc precursors that can compete with UDP-galactose production. NTHi's ability to reversibly inactivate lic2A by phase-variation may influence survival in niches of infection in which UDP-Galactose levels are limiting

Prevalence and characteristics of Complementary and Alternative Medicine use by Australian children

This study was conducted to evaluate the prevalence and characteristics of complementary and alternative medicine (CAM) use, among Australian children and adolescents within the previous 12 months. Methods: Parents with children up to the age of 18 years were recruited from online parenting groups. Questions addressed demographic factors, socioeconomic status, conventional health service use, including vaccination status, and use of CAM. Results: A total of 149 parents responded to the study of which 73.8% (n=110) children had visited a CAM practitioner or used a CAM product in the previous 12 months. The two most frequently visited CAM practitioners were naturopath/herbalist (30.4%) and chiropractor (18.4%). The most commonly used products were vitamins/minerals (61.7%), and herbal medicine (38.8%). Children had also consulted with a general practitioner (89.8%), community health nurse (31.29%) and paediatrician (30.3%) over the same period. A total of 52% of parents did not disclose their child’s use of CAM to their medical provider. Children’s vaccination status was less likely to be up-to-date if they visited a CAM practitioner (OR 0.16; CI 0.07, 0.36; p<0.001) or used a CAM product (OR 0.25; CI 0.09, 0.64; p=0.004). Conclusion: Despite a lack of high quality research for efficacy and safety, many children are using CAM products and practices in parallel with conventional health services, often without disclosure. This highlights the need to initiate conversations with parents about their child’s use of CAM in order to ensure safe, coordinated patient care. The association between vaccine uptake and CAM use requires further investigation

1600 RN

Due to a changing employment arena, healthcare organizations are hiring more new graduate RNs into acute care units. MMC’s usual process is to put new hires into night shift. Historically, night shifts have less resource availability. These combined factors left staff feeling unsupported; patient care could be compromised when less support is available to those in the beginning of their careers

Third Annual Families and Neighborhoods Network Update

Welcome to the Third Annual Families and Neighborhoods Network Update. In this edition, which focuses on Family Development, you'll find plenty of relevant, interesting news, as well as diversity and spirituality in the context of family development.As always, we strive to provide information and resources regarding human service efforts that support families and neighborhoods. The selection of information and articles for this issue of the Network Update was based on issues raised by the seven Comprehensive Community-BasedModels (CCBMs).Among the highlights of this issue is an article by Dr. Susan Stern and Cassandra Clay, professors at Boston University School of Social Work. In their article, titled "Supporting Children and Families in a Caring Community," they challenge our thinking about family development, while guiding practitioners, policymakers, fund providers, and grassroots community-based organizations into the next century.Also in this issue, you'll find two annotated bibliographies that explore community-based, family centered strategies for integrating education and human services. These bibliographies also present practical ways to design policies that reflect the importance of the family in the development of children and society. As an additional resource, you'll also find a directory of federally-funded resource centers and clearinghouses that compile information on child andfamily welfare, health, and education issues.This issue of the Network Update also offers a personal glimpse of the seven W.K. Kellogg Foundation-funded family development sites. Each of the sites was asked to share its definition of family development, and to specify how that definition translates into services or opportunities for families. Staff members at the seven sites also were asked to discuss their philosophies about family development and how that philosophy differs from a mainstream view. Their thought provoking answers are just a few pages away

Implementing evidence-based practice: the challenge of delivering what works for people with learning disabilities at risk of behaviours that challenge

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach: This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings: This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value: In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed

Change in BMI Accurately Predicted by Social Exposure to Acquaintances

Research has mostly focused on obesity and not on processes of BMI change more generally, although these may be key factors that lead to obesity. Studies have suggested that obesity is affected by social ties. However these studies used survey based data collection techniques that may be biased toward select only close friends and relatives. In this study, mobile phone sensing techniques were used to routinely capture social interaction data in an undergraduate dorm. By automating the capture of social interaction data, the limitations of self-reported social exposure data are avoided. This study attempts to understand and develop a model that best describes the change in BMI using social interaction data. We evaluated a cohort of 42 college students in a co-located university dorm, automatically captured via mobile phones and survey based health-related information. We determined the most predictive variables for change in BMI using the least absolute shrinkage and selection operator (LASSO) method. The selected variables, with gender, healthy diet category, and ability to manage stress, were used to build multiple linear regression models that estimate the effect of exposure and individual factors on change in BMI. We identified the best model using Akaike Information Criterion (AIC) and R[superscript 2]. This study found a model that explains 68% (p<0.0001) of the variation in change in BMI. The model combined social interaction data, especially from acquaintances, and personal health-related information to explain change in BMI. This is the first study taking into account both interactions with different levels of social interaction and personal health-related information. Social interactions with acquaintances accounted for more than half the variation in change in BMI. This suggests the importance of not only individual health information but also the significance of social interactions with people we are exposed to, even people we may not consider as close friends.MIT Masdar ProgramMIT Media Lab Consortiu